Doctors Testify About Internist

May 07, 2005|By MATT SABO Daily Press

WILLIAMSBURG — Witnesses vary in their opinions of Dr. J. Howard Shegog, who is accused of overprescribing drugs.

Two pain management specialists offered different assessments Friday of Dr. J. Howard Shegog's care of his patients: One said the suspended physician's care was "laudable and commendable," and the other said it "did not conform to the standards of medical care in Virginia."

Discussing the case of a 46-year-old man, Dr. Martin Ton said that although Shegog wasn't "technically" authorized to wean the patient from methadone, no harm befell the patient.

"Technically, this is a violation," Ton said. "He did a nice thing that got himself in trouble."

Ton, who practices in Virginia Beach, testified as a defense witness in the second day of a hearing about Shegog conducted by eight members of the Virginia Board of Medicine.

The Newport News internist's license was suspended by the board in March. It had concluded that Shegog constituted a "substantial danger to the public health and safety," after the November death of a 30-year-old patient who died of a prescription drug overdose.

The board is hearing evidence surrounding the care of 34 patients, nine of whom died.

Ton said that though Shegog lacked sufficient documentation in medical files to justify treatment of many of the patients, he didn't violate medical standards of care.

In the case of a Shegog patient identified as "Patient D" -- a 40-year-old woman who died of a drug overdose Aug. 12, 2000 -- Ton "lamented the sparse, frugal documentation" that he found in reviewing the woman's file.

Ton said that over three months, he spent 25 hours discussing with Shegog his treatment of patients. Shegog "likes to spend more time with them than document," Ton said.

State documents show that the woman was treated by Shegog on Aug. 10, two days before she died. Ton said Shegog walked a "fine, thin line" in treating the woman, who had a history of substance abuse and drug addiction.

"Dr. Shegog felt she should have treatment of pain," Ton said.

But Dr. Virgil A. Balint, who reviewed 12 cases, testified for the prosecution that Shegog should have noticed drug-seeking behavior in some of his patients. One patient, he noted, was getting narcotic medication from another doctor.

"It's a clear indication that this was a double-dipping case," Balint said.

In other cases, Shegog failed to perform basic examinations to justify the doses of narcotic painkillers that he was prescribing, Balint said. Reviewing the case of "Patient H," Balint said he would have done more investigating into the patient's statements of shoulder pain. A note in the patient's chart read that she had been seen by a specialist who said the pain wasn't musculoskeletal.

Balint said he saw no indications that Shegog tried to pinpoint the nature of the pain.

"The typical symptoms are nowhere in the chart," he said, but Shegog still prescribed narcotic painkillers to the woman.

In reviewing the records of the 30-year-old man who died of a drug overdose in November, Balint noted that the patient told Shegog in a Nov. 9 office visit that he had taken one of his friend's 40-milligram OxyContin tablets and that it provided him good relief for seven to eight hours.

"This should have been a red flag: that the patient was asking for a specific drug and that he got the drug from somewhere else," Balint said.

The patient died Nov. 10. The cause of his death was "acute combined toxicity with OxyContin and Alprazolam," according to state documents.

Other witnesses for Shegog testified about his character and abilities.

A former colleague of Shegog, Dr. Vaughan H. Howard, said he always held Shegog in high regard. Howard, an emergency room physician at Mary Immaculate Hospital, said he worked with Shegog for most of the 20 years that Howard had been at the hospital. He was flabbergasted about allegations that Shegog mismanaged the care of patients, he said.

"I have never seen that in my interaction with Dr. Shegog," he said.

The hearing resumes at 8 a.m. today at the Williamsburg Marriott. Testimony is expected to wrap up during the day before the board begins its deliberations of the allegations against Shegog. *